Dialysis Malnutrition Research Articles

Clinical efficacy and feasibility of whey protein isolates supplementation in malnourished peritoneal dialysis patients: A multicenter, parallel, open-label randomized controlled trial

Poor dietary intake is commonly associated with malnutrition in the dialysis population and oral nutritional supplementation is strategized to redress dietary inadequacy. Knowledge on clinical efficacy of whey protein supplementation (WPS) as an option to treat malnutrition in continuous ambulatory peritoneal dialysis (CAPD) patients is limited. This multicenter, parallel, open-label, randomized controlled trial investigated the clinical efficacy of WPS in 126 malnourished CAPD patients with serum albumin <40g/L and body mass index (BMI) <24kg/m2. Patients randomized to the intervention group (IG, n=65) received protein powder (27.4g) for 6 months plus dietary counseling (DC) while the control group (CG, n=61) received DC only. Anthropometry, biochemistry, malnutrition-inflammation-score (MIS), dietary intake inclusive of dialysate calories, handgrip strength (HGS) and quality of life (QOL) were assessed at baseline and 6 months. Clinical outcomes were assessed by effect size (Cohen's d) comparisons within and between groups. Seventy-four patients (n=37 per group) completed the study. Significantly more IG patients (59.5%) achieved dietary protein intake (DPI) adequacy of 1.2g/kg per ideal body weight (p<0.001) compared to CG (16.2%) although difference in the adequacy of dietary energy intake between groups was non-significant (p>0.05). A higher DPI paralleled significant increases in serum urea (mean Δ: IG=+2.39±4.36mmol/L, p=0.002, d=0.57 vs CG=-0.39±4.59mmol/L, p>0.05, d=0.07) and normalized protein catabolic rate, nPCR (mean Δ: IG=+0.11±0.14g/kg/day, p<0.001, d=0.63 vs CG=+0.001±0.17g/kg/day, p>0.05, d=0.09) for IG compared to CG patients. Although not significant, comparison for changes in post-dialysis weight (mean Δ:+0.64±1.16kg vs+0.02±1.36kg, p=0.076, d=0.58) and mid-arm circumference (mean Δ:+0.29±0.93cm vs-0.12±0.71cm, p=0.079, d=0.24) indicated trends favoring IG vs CG. Other parameters remained unaffected by treatment comparisons. CG patients had a significant decline in QOL physical component (mean Δ=-6.62±16.63, p=0.020, d=0.47). Using changes in nPCR level as a marker of WPS intake within IG, 'positive responders' achieved significant improvement in weight, BMI, skinfold measures and serum urea (all p<0.05), while such changes within 'negative responders' were non-significant (all p>0.05). A single macronutrient approach with WPS in malnourished CAPD patients was shown to achieve DPI adequacy and improvements in weight, BMI, skin fold measures, serum urea and nPCR level. CLINICAL TRIAL REGISTRY: www.clinicaltrials.gov (NCT03367000).

Relationship between Onodera׳s Prognostic Nutritional Index and Subpopulation Lymphocyte Counts in Hemodialysis and Peritoneal Dialysis Patients

Background No standard method for assessing the nutritional status in dialysis patients. In the present study, we undertook an evaluation to determine whether estimation of geriatric nutritional risk index (GNRI) and lymphocyte subset counts can be helpful in diagnosis of malnutrition in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We examined the GNRI and lymphocyte subset counts of 50 HD patients (55.8±12.7 years; 28 men and 22 women) and 16 CAPD patients (49.8±14.5 years; 10 men and 6 women). The GNRI is calculated based on the serum albumin level and total lymphocyte count and uses the following equation: GNRI=[14.89×albumin (g/dL)]+ [41.7×(weight/ideal body weight)]. Logistic regression analysis was performed for predicting malnutrition in dialysis patients. Results The average GNRI value was 100.1±8.4 in HD patients and 99.2±8.1, and GNRI values were normally distributed. lymphocyte subset counts were not different between HD patients and CAPD patients. Lymphocyte subset counts were lower in patients with higher GNRI (GNRI ≥100). According to logistic regression for predicting malnutrition according to GNRI, age, female and CD 19 count predicted malnutrition in hemodialysis and peritoneal dialysis patients Conclusions These results suggest that GNRI and lymphocyte subset counts (especially CD 19 count) may be a significant nutritional marker in HD and CAPD patients.

Icodextrin Dialysate Improves Nutritional and Inflammatory Profiles in Peritoneal Dialysis Patients

Background. Previous studies demonstrate that icodextrin is superior to 4.25% dextrose for fluid removal in patients with high and high-average transport membrane. Recent studies reveal that controlling volume status improves malnutrition in peritoneal dialysis (PD) patients. This study hypothesized that icodextrin enhances nutritional and inflammatory status by improving fluid balance. Methods. This retrospective case-control study investigated the effects of icodextrin on patient nutritional profiles over a one-year period. Thirty-two patients who used icodextrin for more than one year were classified as the “icodextrin group.” Ten patients who used glucose-containing dialysate without icodextrin were classified as the control group. Clinical and laboratory parameters were compared between groups. Demographic and laboratory parameters were analyzed at baseline, 3 months, 6 months, and 12 months after starting icodextrin dialysis. Results. Ultrafiltration of icodextrin per exchange in the icodextrin group was 66% higher than that for 4.25% dextrose exchange in the icodextrin group (icodextrin vs. 4.25% dextrose: 492.1 ± 204.5 vs. 296.1 ± 115.3 mL/exchange; p < 0.0001, paired t-test). The increased albumin and normalized protein catabolic rate (nPCR) after icodextrin for one year was unique for the icodextrin group (p < 0.0001 and p < 0.0001, respectively). The inflammatory marker high sensitivity C-reactive protein (hsCRP) decreased significantly only in the icodextrin group (p = 0.0048). Conclusion. Icodextrin dialysate may improve nutritional and inflammatory status in PD patients. However, the long-term clinical effects of icodextrin require further study.

Nutrition and malnutrition in dialysis

Nutrition and malnutrition in dialysis

Nutrition de l’hémodialysé chronique

Malnutrition in dialysis is of public health concern: in 25% of French hemodialysis patients, survival is compromised by nutritional depletion. To day, nutritional requirements have been defined and nutritional efficacy of supplementation established. Controlled studies are needed to evaluate the effects of nutritional support on the quality of life, health-care requirements and survival, as well as to precise the interest of anabolizing hormones and rehabilitation. Malnutrition in hemodialysis implies to look for treatable causes of anorexia and catabolism and to adapt nutritional therapy to nutritional evaluation: dietary counseling and oral supplement in moderately depleted patients, intradialytic parenteral nutrition or enteral nutrition in severely malnourished.

Malnutrition in dialysis: Malnourishment or uremic inflammatory response?

Malnutrition in dialysis: Malnourishment or uremic inflammatory response?